As COVID-19 descended upon the Charlotte area in early March and stay-at-home orders loomed, staff members with the Queen City Needle Exchange (QCNE) saw a tough road ahead for their program’s participants.
The group, run by the Charlotte-based Center for Prevention Services, curbs risks for drug users by providing safe access to supplies such as clean syringes and overdose-reversal medication like Naloxone. Despite a lasting stigma in many communities, programs like Queen City Needle Exchange have been proven to not only decrease death counts among the drug-using community and curb the spread of HIV and Hepatitis C, but to help direct drug users into recovery programs at their own pace.
For more than two years, QCNE has been operating out of satellite sites such as Hope Chapel north of Uptown and Carolinas CARE Partnership in east Charlotte, but with new social distancing requirements coming down from local government, those sites became impossible to run safely.
Staff knew they needed to make changes, and fast.
QCNE program coordinator Lauren Kestner was in Raleigh for a conference as talk of a stay-at-home order ramped up, and she quickly cut her visit short to return to Charlotte and help her program’s participants.
“We had to open our site on Friday [March 13] because we had to get people stocked up,” she recalled during a recent phone call. “We didn’t know what the governor was about to put up, but we knew that a quarantine/shelter-in-place was coming, and we knew that we had to give out three to four weeks worth of supplies.”
Overdoses in Charlotte spike in a crisis
Kestner was well aware of the specific risks that people who use drugs would face during the COVID-19 crisis: the dangers of using alone, not having access to clean supplies, going through withdrawals with no medical assistance, and other risks that go beyond the underlying health vulnerabilities that their lifestyle would already bring about if they were to catch the virus.
Sure enough, less than a month into the stay-at-home order, those dangers began to play out in Charlotte. According to CMPD, between March 26 when the order was handed down and April 22, police responded to 100 overdose calls, with 10 resulting in deaths. The call total was a 24% increase compared to the same time span in 2019.
“If you listen to the experts across the country, they’re concerned that this spike is going to continue to intensify with some of these stay-at-home orders,” said CMPD spokesperson Rob Tufano at an April 22 press conference. “People are in close quarters together, a lot of anxiety out there with the unemployment spiking and people losing their jobs, so that’s something that the experts are keeping their eyes on, and something that we in public safety are keeping our eyes on.”
In times when the folks they serve are at an even higher risk than usual, the team at Queen City Needle Exchange has taken action in the Charlotte area. Kestner and fellow program coordinator Denae Ayers have gone mobile, meeting participants where they are all around Mecklenburg County and surrounding areas.
For Kestner, the changes have been anything but ideal, due to the risk it puts her and her team at but also because they make it more difficult to connect participants with resources. She continues to go out and deliver supplies every Tuesday through Thursday, however, because she can’t imagine leaving her participants without help.
“The engagements are much different because we’re not in a space,” Kestner said. “It feels and looks very different. We’re all very uncomfortable with it quite honestly. With social-distancing measures, safety protocols, it’s very hard to do aggressive outreach right now. Also, our core QCNE team, we all have children. So there’s a lot of things to consider. But that was what we’ve been able to do.”
Between March 1 and April 16, Queen City Needle Exchange has enrolled 29 new participants, distributed 16,890 syringes and 172 Naloxone kits, and had 19 overdose reversals reported in the Charlotte area. The work she and Ayers are doing is helping, it seems, anecdotally at least. While they’ve seen sharp increases in overdoses not only in Mecklenburg but the five other counties they serve — Union, Stanly, Cabarrus, Rowan and Davidson — they’ve not seen the same among their own participants.
“We’re not ahead of it by any means, but we have worked very hard to curb it and get people Naloxone and other safe and sterile supplies at this time with these restrictions,” Kestner said. “We’ve had reports, but not as many as what MEDIC and CMPD would be seeing, and I think it’s because they’re actively engaged in these programs, and they’re connected with NARCAN [a brand of Naloxone], they know how to respond to the overdose, and they may not be reporting it but lives are definitely being saved.”
Queen City Needle Exchange puts plans on hold
As one of just a couple needle exchanges in the Charlotte area — a local Urban Survivors Union chapter called Point Made launched in 2019 — QCNE has steadily made progress along with its partners in the Charlotte Regional Harm Reduction Coalition. However, recent events have halted its biggest goal for 2020. The team had planned to open a wellness center that will serve as a one-stop for participants, offering not only a fixed site for the needle exchange program, but for peer-led support groups, a community garden and a site for testing and medication-assisted treatment from partnering providers.
The Center for Prevention Services (CPS) runs off donations and grants, the biggest being a 15-month, $275,000 grant from the North Carolina Department of Health and Human Services. During the COVID-19 crisis, the organization has received additional grants from Cardinal Innovations, Novant Health and the Comer Family Foundation.
Much of that money goes to staffing and supplies. CPS spends between $80,000-$86,000 a year on supplies alone, though its seen a sharp increase in that spending during the crisis, sometimes spending as much as $12,000 a week.
According to CPS executive director Angela Allen, the original plan was to dip into the organization’s investment fund with Foundation for the Carolinas to buy a property. However, as is the case with just about everyone, COVID-19 changed everything.
“While I haven’t lost any grants yet, as an executive director I can’t see letting go of our nest egg when I know that we could lose grants, and then we’re talking about the choice of paying for a building or paying for my employees and I don’t want to have to let anybody go,” Allen said. “So I made the decision that we just can’t buy right now. We’ll have to rent until we either raise the capital or things get back to some semblance of whatever normal is going to be.”
That sounds simple enough. However, nothing is simple in the world of a needle exchange.
As Allen expressed in an open letter to community partners on May 8, as she began looking for land to lease around Charlotte, she was repeatedly turned away as soon as landlords learned of her mission.
“We started looking and time after time, landlords would find out what we intended to do and they said, ‘No. We don’t want that kind of activity here,’” Allen told Queen City Nerve. “It doesn’t matter that it’s legal, it doesn’t matter that it’s necessary, that it’s saving people’s lives, they just didn’t want us.”
Allen said she would have expected the pushback in more well-to-do communities such as Myers Park or Ballantyne, but she was dealing with landlords — many of them absentee — who own buildings where a lot of her participants live and work: the Woodlawn/Tyvola road corridors, the Eastway Drive/Central Avenue corridors and Monroe Road/Eastover corridors.
“They’re going, ‘Oh no, we don’t want those kind of people walking around our neighborhood,’” Allen said. “I’m like, ‘Those kind of people are already walking around your neighborhood. Those kind of people are your clients. They’re the people that are coming into your retail establishments.’ If it just happened once it wouldn’t be bothering me so much, but I’ve been turned down by five, or six at this point just because they don’t want our kind. You wouldn’t think that you’d be up against that stigma these days.”
The benefits of a needle exchange in Charlotte
The Centers for Disease Control and Prevention have confirmed that needle exchange programs do not increase drug consumption, and participants are more likely to enter drug treatment programs and stop injecting drugs. However, beliefs about enabling drug use still hold many programs back.
Also, people around the country have voiced other issues with the exchanges. Public concerns about discarded used needles were one factor that led to Madison County, Indiana’s syringe exchange program being shut down in 2017 after two years in operation. The program, run by the county health department, had been created in response to a 30% rise in viral hepatitis cases in 2015. A year later, county commissioners there agreed unanimously to reopen a modified version of the program, which is now run by a nonprofit similar to CPS rather than the county.
On average, Queen City Needle Exchange sees a 45% return rate for its syringes.
Locally, getting county support has never been an issue. Experts in Charlotte know the benefits of a needle exchange program, and they’ve been more than supportive. In other spaces, though, it can be harder to convince people.
“With our public health partners, there’s really never been an issue,” Allen said. “The [Mecklenburg County] health department has been on board from day one; they get it. They see the rising HIV and Hep C rates, they see the overdoses. MEDIC sees the overdose rates and they want to get that down, they’re a huge supporter. There are a lot of people who work in public health and emergency services that have gotten this all along.
“It’s the community, some of the landlords out there,” she continued. “A lot of the elected officials in Mecklenburg County get it, but we still have huge hurdles to go through in some of our more rural counties we serve where the elected officials are not on board with this. And it doesn’t matter that it’s legal, they don’t want to do it.”
Allen said she’s received great feedback since sending the letter out, and is currently in conversation with one landlord who is in the process of buying a property in the Eastway Drive/Central Avenue area so that she can rent it for a few years and buy it when things become more stable.
The group hopes to host a soft re-opening of its Carolinas CARE site in June, though staff members are constantly discussing how they can do that safely, be it through curbside service or by appointment only. In the meantime, Kestner and Ayers will continue hitting the road each week to provide participants with life-saving services, because they don’t see any alternative.
“You’ve got a national public health crisis, which still looms, and a pandemic on top of that, which is only going to exacerbate these things,” Kestner said. Her passion for the program and its benefits projected through the phone anytime she spoke about the stigma surrounding needle exchanges in the Charlotte area.
“The hope that we had for community members for the things that they would be receiving from [the wellness center], especially during a time of such disconnection, to see the stigma and discrimination that we experienced was just the most horrific thing. For a person’s arrogance and ideology to be powerful enough to assume what’s best for a community and a person’s needs, it just triggers every nerve in my body.”
For Kestner and her fellow staff members, it’s the difference between life-and-death, and never more so than now.
For more coverage on how COVID-19 has affected some of Charlotte’s more vulnerable communities, from our homeless neighbors to sanitation workers, follow along with us.